Endocrine Abstracts

JOINT2873

Introduction: Corticosteroid therapy is a cornerstone in the treatment of active and moderate to severe forms of dysthyroid orbitopathy (DO) due to its powerful anti-inflammatory and immuno-suppressive effect

Materials and methods: This retrospective study included 79 patients managed in the endocrinology, diabetology, metabolic diseases and nutrition department of CHU Ibn Rochd in Casablanca, between 2012 and October 2024.

Results: The mean age of patients was 56.7±14 years, with a male predominance (67%), with an F/H sex ratio of 0.49. Bilateral involvement was found in 80% of cases, with asymmetry in 20%. The average duration of OD was 8±5 months. The onset of DO coincided with Graves’ disease in 42 patients, occurred after Graves’ disease in 33, and preceded Graves’ disease in 3 cases. Oral corticosteroid therapy was initiated in 6 patients with mild DO, at a dose of 20 to 30 mg/day for 3 months, with gradual tapering off. Intravenous corticosteroid therapy was administered in 69 of our patients (87%) with moderate to severe active forms, according to 3 protocols Protocol 1: a bolus of 500 mg/week for 6 weeks, followed by a bolus of 250 mg/week for 6 weeks, with a cumulative dose of 4.5g in 51 patients (74%). Protocol 2: a bolus of 750 mg/week for 6 weeks, followed by a bolus of 500 mg/week for 6 weeks, for a cumulative dose of 7.5g in 12 patients (17%). Protocol 3: a bolus of 1g/day for 3 consecutive days, at weekly intervals, followed by 500 mg/week for a cumulative dose of <8g in 6 patients (9%). With regard to the reasons for discontinuation of intravenous corticosteroid therapy, 7 patients developed keratitis, 2 conjunctivitis, 1 hepatic cytolysis, 4 infections (tuberculosis, syphilis, pulmonary infection), and 4 were lost to follow-up. Clinical improvement was objectified by improvement in functional signs with a reduction in the Mourits score from 4 before treatment to 2 after, with a significant improvement in patients’ quality of life.

Conclusion: Corticosteroid therapy, particularly in its intravenous form, is an essential pillar in the management of active forms of DO, offering significant improvement in symptoms when used in an adapted and supervised manner.